ECONOMIC IMPLICATIONS OF ANTIMICROBIAL RESISTANCE
6. ECONOMIC IMPLICATIONS OF ANTIMICROBIAL RESISTANCE
Antimicrobial resistance is not only a medical problem but also an eco- nomic one (Paladino et al., 2002). Resistant organisms cause infections that are more difficult to treat, requiring drugs that are often less readily available, more expensive, and more toxic (Carmeli et al., 1999; Howard et al., 2001). In some cases, certain strains of microbes have become resistant to all available antimicrobial agents (Russo and Johnson, 2003). Resistant Gram-negative and Gram-positive bacteria have been associated with increased direct medical costs ranging from several thousand dollars to tens of thousands of dollars per patient (Paladino et al., 2002). With increasing frequency and levels of AR, drug therapy must be viewed in an economic sense. Several factors impact on cost-effective antimicrobial therapy, including drug cost, drug efficacy and
632 Denis K. Byarugaba duration of treatment, dose regimen, diagnostic strategies, microbial resistance,
and patient compliance. Comparison has been made of the impacts of infections due to antimicrobial- resistant bacteria with those of infections due to antimicrobial-susceptible strains of the same bacteria. Data shows that for both nosocomial and community- acquired infections, the mortality, the likelihood of hospitalisation and the length of hospital stay were usually at least twice as great for patients infected with drug-resistant strains as for those infected with drug-susceptible strains of the same bacteria (Holmberg et al., 1987). Tuberculosis, treatment costs have been estimated at US$20 for regular treatment, while the cost of treating MDR-TB rises to US$2,000 (WHO, 2001). For HIV/AIDS, it has been indi- cated that resistance to one protease inhibitor results in resistance to the entire family of drugs thus implying higher costs of treatment of the insensitive strains. This applies to all other major killers such as ARIs, diarrhoeal dis- eases, malaria, and other STDs which are very prevalent in DCs. Poor out- comes could be attributed both to the expected effects of ineffective antimicrobial therapy and to the unexpected occurrence of drug-resistant infections complicated by prior antimicrobial therapy for other medical prob- lems. Although the adverse economic and health effects of drug-resistant bac- terial infections can only be roughly quantified, AR is an important health problem and an economic burden to society (Cosgrove and Carmeli, 2003).
Unfortunately the costs for production of new drugs and introduction onto the market are enormous, estimated at a minimum of US$300 million. This partly explains the reason why since 1970, there have been few classes of antimicrobial agents developed. Their development also takes a period of 10–20 years. Although DCs have the enormous potential of hotspot virgin tropical forests that harbour a lot of plant resources that may provide solutions to many of the current resistance problems, their exploitation requires similar huge financial resources and time to develop them to market level.
Besides the direct costs, there are also biological costs associated with development of AR (Gillespie and McHugh, 1997; Nyamogoba and Obala, 2002) and more importantly, costs related to loss of life and hours spent with- out productive work during long hospitalisation with resistant disease agents. Table 8 shows the extent of the deaths resulting from major killer diseases in the DCs.
Together, HIV/AIDS, tuberculosis, and malaria claimed 5.7 million lives in 2002 and caused debilitating illness in many millions more (Goeman et al., 1991; WHO, 2002). These are the lives of infants, young children, and young mothers and fathers and the economically most important group in their prime productive years. Resistance to these disease agents puts a heavy burden on the already strained public health.
AR and its Containment in DCs 633
Table 8. Occurrence of the major killer diseases in the world and proportion of their occurrence in developing countries
Disease Deaths per year
Percentage in developing (in million)
New cases per year
countries (%) HIV/AIDS
(in million)
3 5.3 92 Tuberculosis
1.9 8.8 84 Malaria
Nearly 100 Source: WHO (2002).
Parts
» Antibiotic Policies: Theory and Practice
» THEORIES OF FACILITATING CHANGE
» OTHER APPROACHES TO GUIDELINE DEVELOPMENT
» QUALITY ASSURANCE AND DEVELOPMENT OF STANDARDS
» DEVELOPMENT OF CLINICAL STANDARDS IN SCOTLAND
» WHICH QI INTERVENTIONS HAVE BEEN STUDIED IN CAP?
» LINKING PROCESS OF CARE TO OUTCOMES IN QI
» WHAT IS THE EVIDENCE THAT QI INITIATIVES IMPROVE PROCESS OF CARE IN CAP?
» WHAT IS THE EVIDENCE THAT QI INITIATIVES IMPROVE OUTCOMES IN CAP?
» Designing and implementing a CAP intervention
» LEVEL OF AGGREGATION OF ANTIMICROBIALS
» ANTIMICROBIAL USAGE MEASURES
» Relationships based on patient-specific data
» Relationships based on aggregate usage
» ANTIBIOTIC CONSUMPTION; ALTERNATIVE UNITS OF MEASUREMENT
» ANTIBIOTIC CONSUMPTION CALCULATOR
» BENCHMARKING FOR REDUCING VANCOMYCIN USE AND VANCOMYCIN- RESISTANT ENTEROCOCCI IN US ICU S
» THE HARVARD EMERGENCY DEPARTMENT QUALITY STUDY
» ANALYSIS BY INDIVIDUAL ANTIMICROBIAL AGENT
» BENCHMARKING WITH OTHER ANTIMICROBIAL UTILISATION DATA
» STATE OF THE ART OF ANTIBIOTIC PROPHYLAXIS IN SURGERY
» AUDITING AND IMPROVING THE QUALITY OF ANTIBIOTIC PROPHYLAXIS IN SURGERY
» TYPES OF STUDIES TO OBTAIN QUALITY DATA ON A PATIENT LEVEL
» MULTIDISCIPLINARY ANTIMICROBIAL MANAGEMENT TEAMS
» THE ROLE OF THE PHARMACIST IN INFECTION MANAGEMENT
» TRAINING AND SUPPORT IN INFECTION MANAGEMENT FOR PHARMACISTS
» ANTIBIOTIC POLICY IN THE TERTIARY CARE CENTRE
» ANTIBIOTIC CONSUMPTION IN ICU S
» ANTIBIOTIC RESISTANCE IN ICU
» The impact of antibiotic policies and antibiotic consumption on antibiotic resistance
» IT and benchmarking to improve antibiotic prescribing
» COST OF HOSPITAL-ACQUIRED INFECTION
» THE COST OF ANTIMICROBIAL RESISTANCE
» Costs of screening/surveillance cultures
» Isolation, cohorting, and contact isolation
» EPIDEMIOLOGY OF INVASIVE FUNGAL INFECTIONS
» Antifungal resistance in Candida species
» Antifungal resistance cannot be transmitted by extrachromosomal DNA
» RATIONAL USE OF ANTIFUNGAL AGENTS
» THE CHANGING FACE OF VIRAL INFECTIONS AND THEIR MANAGEMENT
» PROBLEMS ASSOCIATED WITH ANTIVIRAL THERAPY
» ANTIVIRAL TREATMENT STRATEGIES
» ANTIVIRAL PROPHYLAXIS STRATEGIES
» ANTIBIOTIC CONCENTRATIONS AT TARGET SITES
» An infant with aplastic anaemia
» A long-standing E. coli infection of liver cysts
» BREAKPOINTS: A SHORT HISTORY AND OVERVIEW
» PHARMACODYNAMIC RELATIONSHIPS AND EMERGENCE OF RESISTANCE
» EVALUATION OF THE ANTIMICROBIAL RESISTANCE SURVEILLANCE DATA PUBLISHED IN THE MEDICAL LITERATURE
» PRACTICAL ASPECTS OF THE IMPLEMENTATION OF THE SURVEILLANCE PROGRAM
» Multivariate analysis methods
» Evolutionary genetic approaches
» Study of the relationship between bacterial resistance and antimicrobial consumption
» To predict the short-term evolution of resistance
» To evaluate interventions to control antibiotic resistance
» DISINFECTANTS: TYPES, ACTIONS, AND USAGES
» Evidence of bacterial resistance to biocides
» Mechanisms of bacterial resistance to biocides
» EVIDENCE OF CROSS-RESISTANCE BETWEEN BIOCIDES AND ANTIBIOTICS
» DISINFECTANT USAGE AND ANTIBIOTIC RESISTANCE
» METHODS OF LITERATURE REVIEW
» PROBLEMS WITH INTERPRETATION OF PUBLISHED STUDIES
» Distribution of educational materials
» Audit and feedback with or without other educational materials
» Educational group meetings or seminars
» Educational outreach/academic detailing
» Financial/healthcare system changes
» EFFECT OF INTERVENTIONS ON ANTIBIOTIC RESISTANCE
» DDD/1,000 INHABITANTS AND DAY (DID)
» PRESCRIPTIONS/1,000 INHABITANTS AND YEAR
» INDICATIONS FOR ANTIBIOTIC PRESCRIPTIONS
» POSSIBLE CAUSES FOR OBSERVED VARIATIONS IN ANTIBIOTIC USE
» DETERMINANTS OF ANTIBIOTIC CONSUMPTION
» COLLECTIVE AWAKENING AND PROGRESSIVE MOBILIZATION OF FRENCH PUBLIC HEALTH AUTHORITIES
» ANTIBIOTIC USE AND COST TRENDS
» IMPACT ON HEALTH BUDGETS OF ANTIBIOTIC USE
» ACCESS TO ESSENTIAL ANTIBIOTICS AT ALL LEVELS OF CARE
» EPIDEMIOLOGY OF ANTIMICROBIAL RESISTANCE
» THREAT OF ANTIMICROBIAL RESISTANCE
» ECONOMIC IMPLICATIONS OF ANTIMICROBIAL RESISTANCE
» FACTORS CONTRIBUTING TO DEVELOPMENT AND SPREAD OF RESISTANCE
» STRATEGIES FOR CONTAINMENT OF RESISTANCE IN DEVELOPING COUNTRIES
» Antibacterial resistance and policies
» Policies, guidelines, and education on antibacterial use
» Discovery, development, and commercialization in the face of policies
» Antibacterial development, labelling, and benefits
» WHAT CAN BE DONE NOW ABOUT ANTIBIOTIC RESISTANCE?
» HOW CAN THE DIAGNOSTIC LABORATORY HELP?
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